Piriformis Syndrome

 Hip Pain with Radiating Pain

Do you or a family member have pain in your bottom that shoots down your leg? Do you have pain down your leg after sitting for long periods of time? That pain pattern is similar to that of piriformis syndrome. Look below for some things to consider!

o   If you do not know the common clinical findings no problem! Click here

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Anatomy

      Image via Complete Anatomy 2018 by 3D4 Medical

Common Movement Fault

A common movement pattern seen in patients that suffer from piriformis syndrome is adduction and internal rotation of the femur. This movement can occur many times through the day going down stairs, squatting, sitting cross legged, or even sleeping on your side and allowing your knee to fall to the bed without putting a pillow between your legs. It is always important to watch how people move! (Click image to watch 1-2 minute video)

Special Tests

A good clinical test to consider when evaluating someone you suspect has piriformis syndrome is the FAIR test. Which is used to rule in/rule out piriformis syndrome by putting the piriformis on stretch. The straight leg raises test can also be useful to determine if there is any neural involvement contributing to the lower extremity pain. (Click image to watch 1-2 minute video. LEFT | RIGHT)

Treatment

Piriformis syndrome can be caused by the sciatic nerve getting entrapped in the piriformis muscle. It is important to work on the entrapment site and then follow up with nerve glides to increase neural mobility. (Click image to watch 1-2 minute video. LEFT | RIGHT)

Therapeutic Exercise

Therapeutic exercises chosen should always closely match treatment given in clinic. It is also important to correct the movement fault to prevent future irritation of the tissue source! This video shows the therapist correcting the patients squatting form. (Click image to watch 1-2 minute video)

Mentoring Minutes on Piriformis Syndrome

Also, check out our Patient Education on PIRIFORMIS SYNDROME CAN BE A PAIN IN THE BUTT

*** CASE NOTES & REFERENCES ***

- Treatment of an Individual with Piriformis Syndrome Focusing on Hip Muscle Strengthening and Movement Reeducation: A Case Report
- Typical treatment: STM, stretching, nerve gliding; 
- 2 year history buttock and post thigh pain
- Movement analysis: Step down (excessive hip add/IR), which had ROS
- MMT : weakness if hip abd and ER muscles
- Treatment: hip strengthening and movement re-education; 
- Outcomes: 0/10 pain with all ADLs’s; 80/80 LEFS improved LE kinematics for peak hip adduction and IR; 
- So instead of pirifmoris being short, its possible to be over lengthened
- Phase 1 (0-4): Bridge with TB; Clam with TB; 
- Phase 2 (4-9): squat with TB; side steps with TB; SL STS; Step down
- Phase 3: functional training: (9-14): forward lunge, lunge at 45 deg, DL jumps, DL to SL lands

Published: Journal of Orthopaedic & Sports Physical Therapy, 2010 Volume:40 Issue:2 Pages:103–111 DOI:10.2519/jospt.2010.3108

Piriformis Syndrome Can Be a Pain in the Butt

Piriformis Syndrome is a controversial diagnosis...

For one thing: there are several other diagnoses that could contribute similar symptoms.  Plus, there are several theories as to what actually causes Piriformis Syndrome in the first place. 

This is where it is so crucial that we, as clinicians, treat each patient individually. 

It's possible that not every patient needs a Piriformis stretch.  If the patient has a stiff Piriformis, sure a stretch is appropriate.  But if movement patterns are faulty and glutes are weak maybe maybe those need addressing. 

Here's an article that will educate your patients on what Piriformis Syndrome is, making sense of the different theories, and offering some exercises that address common impairments.  

continue reading...